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Shoulder Dystocia - NHS Forth Valley

Shoulder Dystocia - NHS Forth Valley


NHS Forth Valley Women & Children’s Unit Shoulder Dystocia H. E.L.P.E.R.R. 2 ENTER Per Vaginam for Internal Rotation Pressure on POSTERIOR ASPECT of ANTERIOR SHOULDER Attempt to rotate fetus into an oblique position – try to deliver – if unsuccessful - Pressure on POSTERIOR ASPECT of POSTERIOR SHOULDER Attempt to disimpact the anterior shoulder. Initially attempt to rotate into an oblique position – try to deliver. If this fails continue rotation of fetus through 180° making the anterior shoulder become posterior shoulder to allow delivery REMOVE Deliver the Posterior arm The operator’s hand is inserted posteriorly along the baby’s arm. The arm is made to flex by putting pressure in the antecubital fossa, the hand is grasped in the operator’s fingers and swept across the baby’s face to deliver the arm. Attempt delivery. This procedure may fracture the baby’s clavicle or humerus ROLL Roll on to hands-knee position Not possible with spinal or epidural in situ Allows better access to remove posterior arm In community situation hands-knee position should be used earlier as it maximizes pelvic diameters Enter Internal Rotation Remove Deliver Posterior Arm Roll To Hands Knee position Zavanelli Manoeuvre - If all else fails Replace the fetal head into the uterus with firm pressure with the palm of the hand to flex the head, so the head is returned to an OA position and maintained in a flexed position from below while a caesarean section is performed ACTIONS TO BE AVOIDED FUNDAL PRESSURE IS DANGEROUS AND SHOULD NOT BE EMPLOYED EXCESSIVE TRACTION/BENDING/TWISTING ON NECK MAY CAUSE BRACHIAL PLEXUS INJURY No fundal pressure No excessive Traction Reference K, Grady C Howell, C Cox (2007) Managing Obstetric Emergencies and Trauma The Moet Course Manual RCOG Press London RCOG (2012) Shoulder Dystocia, Green–Top Guideline 42 June 2014: Review June 2016 or sooner Debbie Forbes/Kirsty MacInnes Version 2.0 5th August 2014 Page 4 of 8 UNCONTROLLED WHEN PRINTED

NHS Forth Valley Women & Children’s Unit Shoulder Dystocia H. E.L.P.E.R.R. 3 Flowchart for the management of Shoulder Dystocia CALL FOR HELP Clinical shift co-ordinator, additional midwifery help, experienced obstetrician, neonatal team and anaesthetist Discourage Pushing Lie flat and move buttocks to end of bed McROBERTS’ MANOEUVRE (Knee’s to ears) SUBRAPUBIC PRESSURE (and moderate axial traction) Consider episiotomy if it will make internal manoeuvres easier Try either manoeuvre first depending on clinical circumstances and operator experience DELIVER POSTERIOR ARM INTERNAL ROTATIONAL MANOEVRES Inform consultant obstetrician and If above manoeuvres fail to release impacted shoulders, consider ALL FOURS POSITION (if appropriate) OR Repeat all the above again Consider cleidotomy, Zanelli manoeuvre or symphysiotomy Baby to be reviewed by Paediatrician after birth and referred for Consultant Paediatrician review if any concerns DOCUMENT ALL ACTIONS AND COMPLETE INCIDENT REPORTING FORM Version 2.0 5 th August 2014 Page 5 of 8 UNCONTROLLED WHEN PRINTED

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